Transscrotal Near Infrared Spectroscopy as a Diagnostic Test for Testis Torsion in Pediatric Acute Scrotum: A Prospective Comparison to Gold Standard Diagnostic Test Study

Bruce J. Schlomer, Melise A. Keays, Gwen M. Grimsby, Candace F. Granberg, Daniel G. DaJusta, Vani S. Menon, Lauren Ostrov, Kunj R. Sheth, Martinez Hill, Emma J. Sanchez, Clanton B. Harrison, Micah A. Jacobs, Rong Huang, Berk Burgu, Halim Hennes, Linda A. Baker

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Abstract

Purpose A rapid test for testicular torsion in children may obviate the delay for testicular ultrasound. In this study we assessed testicular tissue percent oxygen saturation (%StO2) measured by transscrotal near infrared spectroscopy as a diagnostic test for pediatric testicular torsion. Materials and Methods This was a prospective comparison to a gold standard diagnostic test study that evaluated near infrared spectroscopy %StO2 readings to diagnose testicular torsion. The gold standard for torsion diagnosis was standard clinical care. From 2013 to 2015 males with acute scrotum for more than 1 month and who were less than 18 years old were recruited. Near infrared spectroscopy %StO2 readings were obtained for affected and unaffected testes. Near infrared spectroscopy Δ%StO2 was calculated as unaffected minus affected reading. The utility of near infrared spectroscopy Δ%StO2 to diagnose testis torsion was described with ROC curves. Results Of 154 eligible patients 121 had near infrared spectroscopy readings. Median near infrared spectroscopy Δ%StO2 in the 36 patients with torsion was 2.0 (IQR −4.2 to 9.8) vs −1.7 (IQR −8.7 to 2.0) in the 85 without torsion (p=0.004). AUC for near infrared spectroscopy as a diagnostic test was 0.66 (95% CI 0.55–0.78). Near infrared spectroscopy Δ%StO2 of 20 or greater had a positive predictive value of 100% and a sensitivity of 22.2%. Tanner stage 3-5 cases without scrotal edema or with pain for 12 hours or less had an AUC of 0.91 (95% CI 0.86–1.0) and 0.80 (95% CI 0.62–0.99), respectively. Conclusions In all children near infrared spectroscopy readings had limited utility in diagnosing torsion. However, in Tanner 3-5 cases without scrotal edema or with pain 12 hours or less, near infrared spectroscopy discriminated well between torsion and nontorsion.

Original languageEnglish (US)
Pages (from-to)694-701
Number of pages8
JournalJournal of Urology
Volume198
Issue number3
DOIs
Publication statusPublished - Sep 1 2017

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Keywords

  • diagnostic techniques and procedures
  • near-infrared
  • pediatrics
  • spectroscopy
  • spermatic cord torsion

ASJC Scopus subject areas

  • Urology

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